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Question 1
Incorrect
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A 12-year-old boy is brought to the hospital following a road traffic accident. A diagnosis of splenic laceration was made, and a splenectomy was performed. Which among the following blood film findings is not a feature associated with hyposplenism?
Your Answer: Siderotic (iron) granules
Correct Answer: Thrombocytopenia
Explanation:Hyposplenism is associated with thrombocytosis. Other features of hyposplenism are: – Howell-Jolly bodies and acanthocytosis, occurring secondary to haemolysis.- Pappenheimer bodies: These are granular deposits of iron found within the RBCs.- Lymphocytosis and monocytosis.Causes for hyposplenism include:- Congenital asplenia- Iatrogenic splenectomy: Following trauma or treatment for ITP, thalassemia or spherocytosis).- Autosplenectomy: Secondary to sickle cell anaemia, coeliac disease, dermatitis herpetiformis, essential thrombocythemia or splenic arterial thrombosis).
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This question is part of the following fields:
- Haematology And Oncology
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Question 2
Correct
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An 12 year old boy presents with a 2 day history of a tree climbing accident in which a small branch gave way, leaving him suspended by one arm. He can move his arm into any position but is unable to use his hand effectively.Which of the following structures has he most likely damaged in the accident?
Your Answer: The T1 nerve root
Explanation:The boy is most likely to have sustained an injury to his brachial plexus as a result of upward traction of his arm for an extended period of time. We can rule out the topmost nerve roots of the brachial plexus, C6 and C7 as these supply the larger muscles of the arm responsible for moving the shoulder, the elbow and the wrist. The anatomical structure affected is therefore the T1 nerve root which is responsible for movement of the muscles in the hand. This type of injury is called a Klumpke’s Palsy, which is the result of a hyper-abducted trauma to the arm, damaging the C8 and T1 nerve roots. While the radial and ulnar nerve also innervate the hand, the history given points to Klumpke’s palsy as the best explanation for this mechanism of injury.
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This question is part of the following fields:
- Anatomy
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Question 3
Incorrect
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A 26-year-old doctor who has recently been diagnosed with melanoma asks about survival rates associated with this condition. Which of the following statistical methods is employed to predict the survival rates?
Your Answer: Regression analysis
Correct Answer: Kaplan-Meier estimator
Explanation:The Kaplan–Meier estimator, also known as the product limit estimator, is a non-parametric statistic used to estimate the survival function from lifetime data. In medical research, it is often used to measure the fraction of patients living for a certain amount of time after treatment.
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This question is part of the following fields:
- Adolescent Health
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Question 4
Correct
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A 13 year old boy is admitted to the surgical ward with appendicitis. Medical history shows that he has been taking Metoclopramide. He is normally fit and well. However, he is reported to be acting strange and on examination, he is agitated with a clenched jaw and eyes are deviated upwards. What is his diagnosis?
Your Answer: Oculogyric crisis
Explanation:Answer: Oculogyric crisisOculogyric crisis is an acute dystonic reaction of the ocular muscles characterized by bilateral dystonic elevation of visual gaze lasting from seconds to hours. This reaction is most commonly explained as an adverse reaction to drugs such as antiemetics, antipsychotics, antidepressants, antiepileptics, and antimalarials. Metoclopramide is a benzamide selective dopamine D2 receptor antagonist that is used as an antiemetic, with side effects that are seen frequently in children.1 The most common and most important side effects of metoclopramide are acute extrapyramidal symptoms, which require immediate treatment. Acute dystonic reactions occur as contractions of the muscles, opisthotonos, torticollis, dysarthria, trismus, and oculogyric crisis.
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This question is part of the following fields:
- Emergency Medicine
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Question 5
Incorrect
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Which is not a variation of lichen planus?
Your Answer: Follicular
Correct Answer: Sclerotic
Explanation:The clinical presentation of lichen planus has several variations, as follows:- Hypertrophic lichen planus- Atrophic lichen planus- Erosive/ulcerative lichen planus- Follicular lichen planus (lichen planopilaris)- Annular lichen planus- Linear lichen planus- Vesicular and bullous lichen planus- Actinic lichen planus- Lichen planus pigmentosus- Lichen planus pemphigoides
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This question is part of the following fields:
- Dermatology
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Question 6
Correct
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A 14-year-old male was involved in a bicycle accident. He was brought to the emergency department with abdominal pain. On the CT scan of the abdomen, a hematoma was present beneath the capsule of the spleen. His BP and pulse were normal. What is the next step in his management?
Your Answer: Refer to surgeons for observation
Explanation:A surgeon will observe the patient and will decide which procedure he needs.
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This question is part of the following fields:
- Paediatric Surgery
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Question 7
Correct
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Which of the following ages should a child be expected to draw a line and start cutting with scissors?
Your Answer: 2- 2 1/2 years
Explanation:Fine motor development involves greater use of the hands to perform more precise tasks. By 6 -12 months children should be able to reach for small objects and pass an object from one hand to the other. From 1 -2 years they can perform more complex tasks such a building a tower of blocks, feeding themselves, and turning knobs. In terms of pencil skills, they should be able to imitate scribbles and then spontaneously scribble. By the age of 2 years they can draw a line, and by three they can draw a circle. From the age of 3.5 they can draw a cross, 4.5 – a square, 5 – a triangle, and 6 a diamond.
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This question is part of the following fields:
- Child Development
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Question 8
Correct
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A 17-year-old boy is known to make irrational decisions which would normally be considered risky and subsequently gets in trouble with the police. An area in his brain controls judgement, impulse control and planning. Changes in this area of the brain mostly occur until what age?
Your Answer: 20 – 29 years
Explanation:The rational part of a teen’s brain isn’t fully developed until the age of 25 or so.In fact, recent research has found that adult and teen brains work differently. Adults think with the prefrontal cortex, the brain’s rational part. This is the part of the brain that responds to situations with good judgment and an awareness of long-term consequences. Teens process information with the amygdala. This is the emotional part.
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This question is part of the following fields:
- Adolescent Health
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Question 9
Incorrect
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A 15-year-old male presents with a depressed skull fracture, which was surgically managed. Over the next few days, he complains of double vision on walking downstairs and reading. On testing ocular convergence, the left eye faces downward and medially, but the right side does not.Which of the following injured nerves is most likely responsible for the patient's symptoms?
Your Answer: Trigeminal nerve
Correct Answer: Trochlear
Explanation:Based on the clinical scenario provided, the most probable nerve injured in this patient would be the trochlear nerve. The trochlear nerve has a relatively long intracranial course, and this makes it vulnerable to injury in head trauma. Head trauma is the most frequent cause of acute fourth nerve palsy. A 4th nerve palsy is the most common cause of vertical diplopia. The diplopia is at its worst when the eye looks medially which it usually does as part of the accommodation reflex when walking downstairs.
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This question is part of the following fields:
- Ophthalmology
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Question 10
Correct
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Surfactant reduces the surface tension at the air/liquid interface in the lung. Which of the following cells produce surfactant in the lung parenchyma?
Your Answer: Type II pneumocyte
Explanation:Pulmonary surfactant is a mixture of lipids and proteins which is secreted by the epithelial type II cells into the alveolar space.
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This question is part of the following fields:
- Respiratory
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Question 11
Correct
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A 13 year old patient presents in the A&E with a fracture of his left femur. He was a passenger in a car involved in a traffic accident. Upon clinical examination, his left posterior tibial and dorsalis pedis arteries are not palpable. Which of the following is most probably injured?
Your Answer: Femoral artery
Explanation:The femoral artery is the one accompanying the femoral shaft, being the most important blood supplier of the leg. Femoral artery injury during a femur shaft fracture is quite common as a result of blunt trauma.
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This question is part of the following fields:
- Musculoskeletal
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Question 12
Incorrect
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Georgie is a bright 3 year old girl whose development seems to be ahead of her preschool classmates. Which of the following should a typical 3 year old be able to do?
Your Answer: Draw a person with three parts
Correct Answer: Match 2 colours
Explanation:A 3 year old should be able to match two colours, copy a circle, walk up and down the stairs, and jump up and down. By the time they are 4 they can copy a cross, draw a person with three parts, count to 10, stand on one foot.
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This question is part of the following fields:
- Child Development
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Question 13
Correct
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Which of the following statements is true regarding eczema herpeticum?
Your Answer: Is usually associated with lymphadenopathy
Explanation:Eczema herpeticum (also called Kaposi varicelliform eruption) is a disseminated viral illness usually associated with lymphadenopathy.It is most often caused by Herpes Simplex type 1 or type 2. Occasionally, other viruses such as coxsackievirus A16 may cause eczema herpeticum. Affected children usually develop itchy blisters and fever after coming in contact with an affected individual who may or may not display cold sores.It is characterised by an itchy and sometimes painful cluster of blisters most commonly on the face initially. This spreads over one to several weeks resulting in further crops of blisters which can become confluent. Lymphadenopathy and fever are common in these patients.The severity varies from mild illness to life-threatening, especially in immunocompromised children or young infants. It is markedly more common in children with atopic dermatitis. It is one of the few dermatological emergencies, and oral antivirals are often indicated. Referral to an ophthalmologist may be needed if there is eyelid or eye involvement. Occasionally, superadded skin infections caused by staphylococci and streptococci can occur.
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This question is part of the following fields:
- Dermatology
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Question 14
Incorrect
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A mother came to the clinic, with her 7 month old baby. She anxiously explained that he was not responding to loud sounds. He was vocalizing at the presentation and he had normal motor milestones. Which of the following is the most appropriate management?
Your Answer: Reassure
Correct Answer: Arrange Hearing test
Explanation:History is suggestive of a possible hearing impairment. As the baby is vocalizing and has normal motor development, an isolated hearing problem is possible. A hearing test will confirm the diagnosis.
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This question is part of the following fields:
- ENT
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Question 15
Correct
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A 7-year-old boy is diagnosed with metabolic acidosis as a result of severe dehydration. Which of the following conditions is most likely to cause severe dehydration and metabolic acidosis?
Your Answer: Severe diarrhoea
Explanation:Diarrhoea is defined as having three or more loose or liquid stools per day, or as having more stools than is normal for that person. Severe diarrhoea, causing fluid loss and loss of bicarbonate, will result in marked dehydration and metabolic acidosis.
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This question is part of the following fields:
- Fluid And Electrolytes
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Question 16
Correct
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A 15-month-old child is due for his measles, mumps and rubella (MMR) vaccines. He is feverish due to an acute otitis media and the mother gives a family history of egg allergy. What is the most appropriate action?
Your Answer: Defer immunization for two weeks
Explanation:Vaccines should not be given to a feverish child.
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This question is part of the following fields:
- Immunology
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Question 17
Incorrect
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A 4 year old boy, who is mentally unstable, accidentally shoves a pea into his ear while eating. Otoscopic examination reveals a green coloured object in the ear canal. Which of the following would be the best approach to get rid of the pea?
Your Answer: Syringing
Correct Answer: Under GA
Explanation:For Otorhinolaryngologist, removal of foreign bodies (FB) from the ear, nose and throat is one of the common emergency procedures done. Most of the cases especially of the ear and nose can be managed without General Anaesthesia (GA). But in some cases GA may be needed. As the child is mentally unstable, he is unlikely to be able to hold still while the foreign body (pea) is being removed with a forceps, which could result in instrumental damage to the ear canal. Pea is an organic foreign body and not metallic hence the use of magnets would not be of any help either. From the options provided, general anaesthesia would be the best option in this child.
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This question is part of the following fields:
- ENT
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Question 18
Correct
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A screening test is found to have a sensitivity of 90% and a specificity of 95%.Which of the following is the best answer?
Your Answer: An individual without disease is more likely to be correctly diagnosed via the test than someone with the disease
Explanation:The sensitivity of a screening test can be described in a variety of ways, typically such as sensitivity being the ability of a screening test to detect a true positive, being based on the true positive rate, reflecting a test’s ability to correctly identify all people who have a condition, or, if 100%, identifying all people with a condition of interest by those people testing positive on the test.The specificity of a test is defined in a variety of ways, typically such as specificity is the ability of a screening test to detect a true negative, being based on the true negative rate, correctly identifying people who do not have a condition, or, if 100%, identifying all patients who do not have the condition of interest by those people testing negative on the test.
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This question is part of the following fields:
- Epidemiology And Statistics
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Question 19
Correct
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A 7 day old baby weighed 3.5kg when born. His weight is now 3kg. Choose the most appropriate next step for this child.
Your Answer: Continue regular child care
Explanation:In the first week after birth, it is normal for the baby to lose weight and then gain it again. Therefore, regular child care should be maintained.
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This question is part of the following fields:
- Child Development
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Question 20
Correct
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A 7-year-old girl was brought to the hospital with complaints of fever. 5 days ago, she was taken to her GP with lower abdominal pain and leukocytes 3+ on urine dipstick. She was treated with trimethoprim. On examination, she is found to have a low-grade pyrexia, a CRP of 254 mg/L, and a palpable mass in the right iliac fossa. She is able to consume both solids and liquids. Based on the clinical scenario, what is the probable diagnosis and most appropriate management for this child?
Your Answer: This is an appendix mass and intravenous antibiotics where observation is the initial treatment
Explanation:The most appropriate diagnosis for this patient is appendicular mass. The initial treatment, according to the Ochsner-Sherren regimen recommended by Hamilton Bailey, would be the initiation of intravenous antibiotics.RationaleThe presentation is highly suggestive of appendicular mass. The correct management is broad-spectrum intravenous antibiotics such as co-amoxiclav and amikacin plus observation. Conservative management is the preferred treatment as surgical exploration at this stage can result in increased morbidity.The child should be allowed to eat and drink. If there are on-going temperature spikes, signs of obstruction or severe colicky abdominal pain, then surgery is required. The majority of patients respond to conservative management.Other options:- This is a partially treated appendicitis which has formed an appendix mass. Rather than planning appendectomy immediately| Hamilton Bailey recommended interval appendectomy after 6 weeks post-discharge. However, the need for interval appendectomy is still under debate.- Drainage via interventional radiology is not recommended in this patient as it can lead to swinging pyrexia secondary to peritonitis secondary to the collection.- The patient would have high-grade pyrexia and be constitutionally unwell if the patient was a patient of pyelonephritis. The presentation of the patient is more suggestive of appendicular mass.- The history would be more extended with symptoms of weight loss and altered bowel habit if the patient had Crohn’s disease.
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This question is part of the following fields:
- Paediatric Surgery
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SESSION STATS - PERFORMANCE PER SPECIALTY
